Prozac made my depression worse; now I'm scared to try another SSRI.
October 20, 2010 5:53 PM   Subscribe

Prozac made my depression much worse; now I'm scared to try another SSRI.

Background: Female, mid-30s. Family history of depression and anxiety. I've been under extreme stress for the last ten years and would say that feeling down and unmotivated has become my default state. Then a recent breakup triggered a pretty dark episode. At my doctor's recommendation, I started Prozac. She recommended it for its "stimulating" effect, and also because it would help with anxiety and negative thoughts. The first two days I took it I felt great (and I know there's differing opinions on whether I would feel better that soon) but after that I started having some severe panic attacks. My doc prescribed Xanax, which helped a little, but then my depression got 10x worse--to the point that I had to take a week off work because I was literally weeping and and unable to move from my couch or focus on anything. The only time I started to feel better was late at night, when I would have to take my next dose.

My doctor's response was: we can reduce your dose to every other day (I was only taking 10 mg to start because I'm pretty sensitive to all medications), we can try something else, or you can wean yourself off of it and take nothing. I was already a week in, so I decided to reduce the dosage and hope that I would get over the rough patch. By the end of the second week, I wasn't any better.

I know it takes 4-6 weeks to fully feel the effects, but I don't think that "worsening depression" is one of the usual side effects. I know YANMD, but has anyone experienced a similar "worsening" effect before they felt better? Should I see a psychiatrist instead of my GP? I can't afford to lose more time from work and I'm still feeling "off" while its getting out of my system. I really want to start to feel better so I can start making some changes in my life, but I honestly never want to feel as sad and hopeless as I was while I was taking the Prozac, so I'm a little scared to try another SSRI.
posted by anonymous to Health & Fitness (25 answers total) 6 users marked this as a favorite
...but I don't think that "worsening depression" is one of the usual side effects.

I've been through the grinder w/r/t to psych meds and "usual side effects" tend to mean bupkis. The drugs do what they do to you and you and your doctor need to figure it out from there. Which leads to the next part:

Should I see a psychiatrist instead of my GP?

YES. If you're having "unusual" side effects, you need to go to a specialist. A GP can only get you so far. Of course, there's are psychiatrists who will be "worse" than your GP, but your highest chance of getting on the right medication is through a psychiatrist. I'm a little scared to try another SSRI.

There are antidepressants that are not SSRIs. Off the top of my head, there is Efexor, which is an SNRI, and Welbutrin, which is a dopamine inhibitor. Don't write off the field because you had a bad experience with one certain sort of medication.

I suggest you do some research over at crazymeds. Don't play armchair psychiatrist, but get some knowledge so the next time something is suggested to you, you know what's up.

Good luck.
posted by griphus at 6:02 PM on October 20, 2010 [2 favorites]

Oh, and feel free to MeMail me.
posted by griphus at 6:03 PM on October 20, 2010

Please see a psychiatrist, not a family doctor/GP. I'd gone through a few SSRIs until settling on Celexa (available as a generic but I don't know the name of it) with a mild - very mild - dose of clonazepam to counter anxiety symptoms.
Only a psychiatrist IME is compenent to evaluate medication effects, look to your depression/anxiety, and draw intelligent prescriptive conclusions for it. Therapy wouldn't be limited to drugs, you need to talk. A GP just can't focus on that.
I was, but am not scared anymore, and I thatnk a psychiatrist for that.
posted by nj_subgenius at 6:05 PM on October 20, 2010

arrgh compenent=competent. thatnk=thank. ok!
posted by nj_subgenius at 6:07 PM on October 20, 2010

I was first prescribed Wellbutrin for my depression, because it was working really well for my dad. I spent the next three weeks with acute social anxiety -- I couldn't tell if the depression was better because I couldn't leave my dorm room. Talked to my shrink, he put e on Effexor, and it worked great. Still does.

Anti-depressants are only predictable up to a point. Get thee to an actual psychiatrist, and get a different medication. You'll find the one that works for you.

Worsening depression is a side effect of many anti-depressants -- such as Effexor. I (not a psychopharmacologist) figure that if you get that side effect, the medication is not targeting the neurotransmitter that's causing your particular depression. So get another doc to get you on something different.
posted by freshwater at 6:15 PM on October 20, 2010

Wellbutrin gave me panic attacks, Paxil made me suicidal, but Zoloft was fine. You shouldn't discount all antidepressants just because one is bad for you. But man, the 4-6 week wait time sucks.
posted by elsietheeel at 6:33 PM on October 20, 2010

You definitely need to see the psychiatrist/med specialist. I don't want to alarm you but sometimes people who have a latent tendency to develop bipolar or bipolar type two are triggered into the disease/disease exposed by the use of an unopposed antidepressant. I am NOT saying you have this condition but it would be wise in the extreme to be screened by a trained competent medical professional.

FWIW the type two version bipolar is very often misdiagnosed as depression. Fortunately these days meds such as Lamictal are extremely helpful in those cases.

It also could simply be that prozac was simply a very bad fit for you medically. Again, you want a practitioner who really knows his or her stuff to help you navigate through all this.

And I vouch for the Crazymeds site. Over a decade ago the founder was an internet friend of mine and he really knows his stuff.
posted by St. Alia of the Bunnies at 6:34 PM on October 20, 2010

Oh, and unless you really have no choice, avoid Effexor. From what a lot of people have mentioned it's a real bitch to wean off of.
posted by St. Alia of the Bunnies at 6:36 PM on October 20, 2010 [2 favorites]

My spouse (in his late 50's) experienced panic attacks on Wellbutrin after taking Prozac for about 10 years and needing to take more and more to control his symptoms. After the panic attacks, we decided to take a totally different approach to his health care.

He changed to an MD who specializes in anti-aging and hormone replacement. The doctor made no promises, but over the next year my husband lost 60 pounds, felt better than he had in 25 years, and gradually cut his Prozac dosage as he started to experience overdose symptoms. Today he's been off the SSRI's for more than six months and says (and acts like) he feels terrific. He's maintained his weight and no longer needs to use a CPAP machine. He looks great!

I was so impressed with his results that I changed to the same doctor. So far (about nine months), I've lost 50 pounds and my cholesterol has dropped from 244 to 177. I feel and look great, and wish I'd changed doctors years ago...

I expect to receive the usual criticism and warnings from the more traditional MD's on MF, but everyone we know who has gone this route has had excellent results. I suggest reading Neal Rozier's book How to Achieve Healthy Aging, and then find a doctor practicing this method of health care. It's been -- literally -- a life saver for both of us.
posted by northernlightgardener at 6:39 PM on October 20, 2010 [2 favorites]

I had panic attacks on prozac. Switched to zoloft and have found it very helpful. I am hypersensitive to many meds.

You deserve to feel better. You deserve to have a doctor really work with you to find the right meds, which may not be easy. Depression is serious. People die from it. Getting better allows light back into your life. Please work with your doc, or another doc or psychiatrist, to get on the right meds for you.
posted by theora55 at 6:49 PM on October 20, 2010

Lots of great advice. I really can't add much to what griphus said. Solid advice.

In my own experience, finding the right combo of psych meds isn't just a long term's like an ever ongoing process. But if the Prozac is making you feel worse, then yeah, you need to try something else. Every SSRI and every person's reaction to it is totally different. It's a really inexact science (by nature). And, for better or for worse, experiment trials are the only way to really figure out what's working. If it's making you feel that much worse so soon, I doubt a huge turn around will occur at the 6-week mark.

BUT, like people have said, every SSRI (or multi-reuptake inhibitor or benzo or whatever) is really different, and you shouldn't write off all SSRIs based on your Prozac experience. I was on Zoloft for some time before switching to Cymbalta, which I like better. It's really trial and error, even within the same drug category.

You DO need to see a psychiatrist for this, however. Your GP obvs means well, but see a specialist. They'll be better able to help you.

The crazy-med route is necessary for some of us. It isn't an easy route and can be really confusing and emotionally and physically taxing and all sorts of things. But alas, without them, I wouldn't be here, so don't lose heart. Try something else, see a psychiatrist.
posted by Lutoslawski at 6:56 PM on October 20, 2010

Prozac had very negative effects for me as well. For many who suffer the depression/anxiety combo, it can really exacerbate the anxiety.

Do not give up on the idea of medication. try to get to see a psychiatrist, please.

I'd rather not get into my personal stuff too much, but my gp's prescription was changed by a psychiatrist and it was the best thing that's happened to me recently.

memail me if you want to talk specifics.
posted by dogwalker at 6:57 PM on October 20, 2010

Yeah, I think this thread is demonstrating well that SSRIs are just highly individual and unpredictable. On one, I think it was Zoloft but I can't remember for sure, I had extreme LSD-like hallucinations. Eventually Wellbutrin was the answer for me, and thats not even an SSRI (it's a dopamine reuptake inhibitor). My issue was anxiety though, which is different from depression of course. But the only way to find the right drug (if there even is one, not everyone can be helped via medication) is to have a good psych/doctor and try different ones.
posted by wildcrdj at 7:05 PM on October 20, 2010

Nthing seeing a psychiatrist, one who is very familiar with different antidepressants and their side-effects, and who will follow up with you regularly. Most antidepressants, even the ones that work, have strange side effects at first and take a few weeks to settle into your system, and you really need a professional to keep an eye on you until you've found something that really works.

Worsening depression can happen with antidepressants, and it's a sign that you need to get off it and on something else right away.

Antidepressants work differently for everyone, so it's hard to tell what will work until you try it. The variety of anecdotes about Wellbutrin thus far are a good example - it works great for me. I liked Cymbalta a lot too, but I know some people have awful experiences with the side effects. And so on. (If it's worth anything, the only person I know who was prescribed Prozac absolutely hated it.)

The trial-and-error part of going on antidepressants can be inconvenient and annoying at best. But when you find something that works, it's worth it. Good luck and keep fighting.
posted by Metroid Baby at 7:45 PM on October 20, 2010

Just another anecdote, I'm on Effexor (which affects serotonin AND norepinephrine) and I love it. It's the only thing I've found that works for me. Like everyone else has said, all because one drug in a class of drugs doesn't work, doesn't mean they all don't. I recently switched to Pristiq (very similar to Effexor) and I ended up in the hospital with suicidal thoughts and a major anxiety episode (just check out my last askmefi!) I'm back on Effexor now and doing waaaay better. I hope you can find a drug that works for you!
posted by lizjohn at 7:54 PM on October 20, 2010

Trying an antidepressant that's bad for you is a hideous experiece, because side effects can be physical as well as mental. And you're depressed, anxious, and worried, which makes it hard to be very hopeful. But I've tried 3 different ssris, and have had three very different experiences. The same thing happened to my sister, plus her reactions to the drugs were different from mine. There's no way for anyone, even an experienced psychiatrist, to predict how a given antidepressant is going to affect a person.

I encourage you to try another ssri -- and another if the second one is no good. I really wish you luck. When you find one that's good for you, you'll know.
posted by wryly at 7:57 PM on October 20, 2010

Should I see a psychiatrist instead of my GP?

Yes. GP's can prescribe medications, including psychoactive medications, but they aren't trained in diagnosing psychological problems. If she described Prozac's effects as stimulating, she's incompetent, or at least misrepresenting the effects of the drug. Prozac is not a stimulant. You should see a psychiatrist.

It quite possible that feeling feeling great for a few days might have been a placebo effect - a psychological reaction to the fact that you were getting treated, without the drug doing anything at this point. It's possible that prescribing Xanax, a depressant, on top of it didn't make sense. It might make sense for you to get a prescription for an anti-depressant in the shot run plus some talk therapy, since your depression is a reaction to a break-up, and doesn't suggest anything is basically wrong with you. But I don't know.

You should get an appointment with a psychiatrist, if that's an option. A psychiatrist should be able to give you an accurate diagnosis, understand how drugs they might prescribe to you work, a recommend appropriate treatment.
posted by nangar at 8:09 PM on October 20, 2010

In case you find this useful, here's a graph of various depression treatments with their effectiveness plotted against their popularity.

posted by Earl the Polliwog at 8:30 PM on October 20, 2010 [3 favorites]

Celexa or Wellbutrin mysteriously caused me to gain 40 lbs in 3 months despite no change in diet - so that was fun and helpful.

Personally, I am a big fan of NO NONE NOT anti-depressant meds because I have found out since my experience that dr.'s really have no clue how anti-depressants work, or how they will work on any particular person (see yours, mine, and other mefite experiences in the comments above...)

In the end, that anti-depressant medication russian-roulette thing just isn't worth it to me - YMMV.

I'm sorry for your pain. I've been there. I know how hard it can be to overcome a massive wall of hurt and stress crashing in on you.

You say you've had 10 years of stress? I'm wondering if there are things in your life that you believe that you can not change, but maybe you could if you had help? I'm wondering if therapy, with the specific goal of identifying and altering situations and relationships that don't support you, might be more helpful than drugs? I'm wondering what else you've tried prior to meds (exercise? acupuncture? meditation?) and if you had any success?

Anyway, I don't think much will help if you feel limited in life to participating mostly in situations (jobs, relationships) that suck you dry emotionally. I gently suggest you start looking into practical help with the actual identifiable issues (try therapy?) before going back to meds, since even a low dose of prozac caused you to become immobile with fear and miss work.

Plenty of folks overcome depression without meds. Maybe look into alternatives while seeking a competent psychiatrist - just to have options?

Hey - I usually don't pipe in here about anti-depressant questions because so many folks promote reliance on them despite admitting bad experiences... but your story just absolutely seemed like something I couldn't keep quiet about. The most important thing is that you don't quit seeking emotional health. Just in case you were thinking your only choice is to turn to meds, I wanted to make the suggestion you keep your options open as you seek treatment. If something makes you feel bad - don't take it. 5 years ago, I wish I had followed that advice myself instead of following my doctor's advice, someone who only saw me once a month for 45 minutes, at best. YMMV. And Good Luck.
posted by jbenben at 8:30 PM on October 20, 2010 [1 favorite]

I tried going on Celexa because I thought, "hey, I'm on a low dose of Effexor; maybe I can switch over to something with fewer supposed side effects." TERRIBLE idea. I was crazier on Celexa than I was without any drugs at all. Literally crazy. Effexor is currently the one for me, and I feel like a nice normal person.

Some drugs will work wonders for you. Some drugs will absolutely not. I understand how hard it can be to try and try and try when feeling reluctant to try is part of the disease itself. But if taking a pill can help smooth the way for you feeling better, why not just see how it goes? You and your life are worth it.
posted by Madamina at 9:03 PM on October 20, 2010

I know it takes 4-6 weeks to fully feel the effects, but I don't think that "worsening depression" is one of the usual side effects. I know YANMD, but has anyone experienced a similar "worsening" effect before they felt better? Should I see a psychiatrist instead of my GP?

I have struggled with depression for over ten years, and the only times I have felt worsening depression are when I am on a medication that is not right for me. So that's one personal anecdote. In terms of side effects, it's pretty much a matter of what you're willing to put up with, and for how long, in exchange for feeling better. Prozac obviously wasn't doing anything good for you. That doesn't mean that all SSRIs will make you feel that way, though! Celexa made me a fire-breathing bitch, but Zoloft worked terrifically well for many years. And there are lots of other types of meds besides SSRIs. You have a lot of options--you don't have to "stick it out" with something that makes you feel bad.

You really should see a psychiatrist. They will be much more qualified to help you find a medication that works for you--not because your GP is a bad doctor, but because psychiatrists focus only on meds for your brain and will have a better understanding of your options.

Do check out Crazy Meds as others have suggested, to get an idea of the types of medications used to treat depression. The site is as comprehensive as those lengthy drug information sheets they give you at the pharmacy, but written in a much more helpful way.

It might be a good idea for you to start keeping a medication log as you try to find something that helps you. This is just a folder or binder where you keep the following: a copy of the prescription information sheet for the medication you are on; a list of the medication you're taking, at what dose, beginning on date x and ending on date y; side effects you experience; and how the medication makes you feel better (if it does). This list will help you track what works for you and what doesn't. That way, if you get a new doctor, or are on meds long term, or go off them and need them again in the future, you have a record of what you've tried.

I can't afford to lose more time from work and I'm still feeling "off" while its getting out of my system.

I don't know if you are in the US, and if not, this may not be helpful, but if you are being treated for depression, your employer may have to make allowances for you in accordance with disability laws. For example, they may not be able to fire you for missing work if your absences are related to your depression. But "can't afford" might also mean that you don't have paid sick time and need to work to pay the bills, which is understandable. I just wanted to mention that you might have that option, and to look into it if you need it.

Hopefully this information is not completely overwhelming. There are a lot of medications available, and it can seem exhausting trying to find one that works. I had to do some changing up a few years ago, and I definitely spent some weird days weeping on the couch, too. But it will be okay! Your doctors are there to help you, and together you will find something that works. Don't give up! You deserve to feel better and feel positive about your life. You're taking good steps towards that.
posted by Fui Non Sum at 9:09 PM on October 20, 2010

lizjohn: "Just another anecdote, I'm on Effexor (which affects serotonin AND norepinephrine) and I love it. It's the only thing I've found that works for me. Like everyone else has said, all because one drug in a class of drugs doesn't work, doesn't mean they all don't. I recently switched to Pristiq (very similar to Effexor) and I ended up in the hospital with suicidal thoughts and a major anxiety episode (just check out my last askmefi!) I'm back on Effexor now and doing waaaay better. I hope you can find a drug that works for you!"

This is the exact same thing that happened to me. Effexor is the best drug I've found for me, but Pristiq made me worse. There are horror stories about weaning off almost every SSRI/SNRI, please don't judge a med based on that.

Don't be scared, depression meds are trial-and-error. Hopefully you won't need to try many to find one that works for you.
posted by IndigoRain at 11:23 PM on October 20, 2010

I tried I think nearly every SSRI and they did not help me, either, and in fact increased my anxiety and made me feel worse. Pristiq has helped me, although I think as someone mentioned, Effexor/Pristiq are not SSRI's. Everyone's chemistry is sooo different it's trial and error as to what will work for you and the waiting it out sucks! But speaking for me, it has been worth it. My life is so much better today. Don't get me wrong, no medication is perfect. I have sexual side effects I hate. Every once and a while I will think I don't need the medication and then friends and family will remind me and I rethink that. Yes, weaning off of medications is very difficult. There are positives and negatives to everything in life. For me, the positives have greatly outweighed the negatives.
posted by heatherly at 7:24 AM on October 21, 2010

St. Alia of the Bunnies wrote: "From what a lot of people have mentioned it's a real bitch to wean off of."

My SO takes Effexor and hasn't really had a major problem with it on the rare occasion she can't get her dose. Her anxiety comes back somewhat heightened, of course, and she gets insecure, but no crazy brain zaps or anything. Getting on and off relatively easily is just a matter of titrating properly for most people. She only takes 125mg a day, though. If a person needs more, it will obviously be more difficult.

That said, some folks have bad reactions to it, as with any psychoactive drug.

The reason Effexor has a bad reputation is that it gets flushed from your body very quickly, so if you stop, you've just gone completely cold turkey in 12 hours. Most other SSRIs and SSNIs don't get metabolized so fast, so they stick around in the bloodstream for days after you quit taking them, so the process of getting off them is simpler.
posted by wierdo at 6:44 PM on October 21, 2010

I know it takes 4-6 weeks to fully feel the effects, but I don't think that "worsening depression" is one of the usual side effects

You're wrong. It's an expected effect in the first few weeks of SSRI use. The trick, which you have failed to perform, is not to stop the medication when it occurs.
posted by Protocols of the Elders of Sockpuppetry at 3:59 PM on October 23, 2010

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